Provider Demographics
NPI:1114051760
Name:TATE, LINDA W (PSC II)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:W
Last Name:TATE
Suffix:
Gender:F
Credentials:PSC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 MARINA VILLAGE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6427
Mailing Address - Country:US
Mailing Address - Phone:510-747-0527
Mailing Address - Fax:510-337-7969
Practice Address - Street 1:1027 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4511
Practice Address - Country:US
Practice Address - Phone:707-558-1600
Practice Address - Fax:707-558-1606
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN9219988101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor